Laparoscopy
A nation’s experience of bleeding complications during laparoscopy

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Abstract

Background: Bleeding complications during laparoscopic surgery are rare but probably underreported. The aim of the current study was to elucidate the clinical relevance of bleeding complications and major vascular injuries during standard laparoscopic procedures.

Patients and methods: The Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing different standard laparoscopic procedures (1995 to 1997). These data were analyzed with special interest in intraoperative and postoperative bleeding complications and major vascular injuries.

Results: In all, 331 patients (2.3%) had intraoperative bleeding complications. Whereas 44 patients suffered from an external bleed of the abdominal wall, the bleeding was internal in the remaining 287. Thirty-three patients with internal bleeding required blood transfusion with a mean blood loss of 1,630 mL. Surgical hemostasis was necessary in 68% of external and 91% of internal bleeds. There were 250 patients (1.8%) with postoperative bleeding complications. External bleeding occurred in 143 patients, and 107 patients developed internal bleeding. External bleeding was mainly treated conservatively (92%), whereas 50% of internal bleeds required further surgical intervention. Major vascular injuries occurred in 12 patients (incidence 0.08%) with open treatment being necessary in all cases.

Conclusions: Bleeding complications are, in fact, common during laparoscopic surgery. Meticulous dissection technique, immediate recognition, and adequate surgical treatment are mandatory for their management.

Section snippets

Patients and methods

Since 1995 the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) has prospectively collected the data from patients undergoing various laparoscopic procedures at 97 surgical institutions (university, county and district hospitals, and surgeons in private practice). Data from more than 65% of all laparoscopic procedures performed in Switzerland have been collected. For every patient 130 single items including personal records, indication for surgery, intraoperative findings,

Characterization of patients and surgical procedures

There were 6,084 male (42.7%) and 8,159 female patients (53.3%) with an mean age of 51.4 years (range 6 to 95); 3.8% of the patients were <20 years old, and 15.0% were >70 years of age. In addition, most of the patients (90.3%) presented in a low-risk condition according to ASA 1 and 2 classification.

Among the 14,243 patients, there were 581 patients with bleeding complications (4.1%). Whereas 331 patients had an intraoperative bleed (2.3%), the remaining 250 patients had a postoperative

Comments

The aim of our current series was to investigate the clinical importance of bleeding complications after different laparoscopic procedures performed in Switzerland. To this end, the SALTS data base of 14,243 patients, which reflects a representative profile of Swiss laparoscopy, was analyzed.

The overall rate of bleeding complications (IBC and PBC) was 4.1%. In comparison with the available data of the literature, the bleeding complication rate of our series is twice as high.7, 8, 9, 12, 14, 15,

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